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Van Hoecke F, Lamont B, Van Leemput A, Vervaeke S. A Lemierre-like syndrome caused by Staphylococcus aureus: an emerging disease. Infect Dis (Lond) 2019; 52:143-151. [DOI: 10.1080/23744235.2019.1691255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- Frederik Van Hoecke
- Department of Laboratory Medicine, Sint Andries Hospital, Tielt, Belgium
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
| | - Bart Lamont
- Department of Neurology, Sint Andries Hospital, Tielt, Belgium
| | - Ann Van Leemput
- Department of Radiology, Sint Andries Hospital, Tielt, Belgium
| | - Steven Vervaeke
- Department of Laboratory Medicine, AZ Delta Hospital, Roeselare, Belgium
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Methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome: case report and literature review. The Journal of Laryngology & Otology 2013; 127:721-3. [DOI: 10.1017/s0022215113001035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Community-acquired methicillin-resistant Staphylococcus aureus is a growing health concern. Lemierre's syndrome is a septic jugular thrombophlebitis that primarily affects young adults. This paper aimed to identify a possible sub-group of Lemierre's syndrome cases associated with community-acquired methicillin-resistant Staphylococcus aureus.Method:This paper reports the case of a 16-year-old male who was admitted for increasing fever, tachycardia, tachypnoea and neck pain. The patient was diagnosed with methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome. A literature review was subsequently conducted.Results:Following intravenous antibiotic treatment and the sterilisation of blood cultures, the patient improved. The literature review indicated a rise in the past 2 years of Lemierre's syndrome associated with methicillin-resistant Staphylococcus aureus among patients less than 18 years of age.Conclusion:Community-acquired methicillin-resistant Staphylococcus aureus bacteraemia can lead to pulmonary sequelae. When it is associated with pharyngitis, nasopharyngitis or parapharyngeal lymphadenitis, the affected patient may be predisposed to Lemierre's syndrome. As bacterial carriage is predominantly nasal, pharyngitis may not be present. Methicillin-resistant Staphylococcus aureus should be included as an offending bacterium where there is suspicion of Lemierre's syndrome. It is unclear whether anticoagulation alters the course of the bacterium, and surgery is probably contraindicated.
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Stauffer C, Josiah AF, Fortes M, Menaker J, Cole JW. Lemierre syndrome secondary to community-acquired methicillin-resistant Staphylococcus aureus infection associated with cavernous sinus thromboses. J Emerg Med 2012; 44:e177-82. [PMID: 22989693 DOI: 10.1016/j.jemermed.2012.02.075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/04/2011] [Accepted: 02/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Lemierre Syndrome (LS) is a highly aggressive rare disease process with a predilection for young, healthy adolescents. Often beginning with a primary cervicofacial infection, LS rapidly progresses to thrombophlebitis of the cerebral vasculature, metastatic infection, and septicemia. Untreated LS can be rapidly fatal. Thrombus within the cerebral vasculature can have devastating neurological effects. Advances in antibacterial therapy have resulted in a global decline in the incidence of LS, and clinicians may not consider LS early in the disease process. Although the mortality of LS has declined, the morbidity associated with the disease has increased, particularly the neurological sequelae. OBJECTIVES This report will provide readers with a better understanding of the etiology, clinical presentation, evaluation methods, and appropriate treatment of LS. CASE REPORT We present an atypical case of LS secondary to community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection progressing to bilateral cavernous sinus and ophthalmic vein thromboses with resultant binocular vision loss secondary to optic nerve and retinal ischemia. CONCLUSION This case highlights the importance of early recognition of LS in the setting of a community-acquired MRSA infection as the unifying condition in a young patient with multiple acute neurologic impairments.
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Affiliation(s)
- Craig Stauffer
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Abstract
We report a case of Lemierre syndrome secondary to Streptococcus pyogenes in a 22-month-old girl. This case report and literature review took place at a pediatric intensive care unit at a freestanding tertiary children's hospital. Diagnosis occurred after the discovery of left internal jugular thrombus and multiple metastatic infection sites including the right knee, kidneys, lungs, and brain. Lemierre syndrome can occur in young children secondary to S. pyogenes, and a classic presentation may not occur. A high index of suspicion is crucial to the diagnosis.
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Romano L, Spanu T, Calista F, Zappacosta B, Mignogna S, Sali M, Fiori B, Fadda G. Tsukamurella tyrosinosolvens and Rhizobium radiobacter sepsis presenting with septic pulmonary emboli. Clin Microbiol Infect 2011; 17:1049-52. [DOI: 10.1111/j.1469-0691.2010.03396.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Methicillin-resistant Staphylococcus aureus USA300 clone as a cause of Lemierre's syndrome. J Clin Microbiol 2011; 49:2063-6. [PMID: 21430106 DOI: 10.1128/jcm.02507-10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We describe a case of a young woman who had methicillin-resistant Staphylococcus aureus USA300 clone (MRSA-USA300)-associated Lemierre's syndrome and secondary necrotizing pneumonia and cerebral infarcts. We also review 11 cases of S. aureus-associated Lemierre's syndrome reported in the literature from 1965 to 2010. Recognition of S. aureus as an emergent cause of Lemierre's syndrome informs the initial empirical antibiotic choice for this life-threatening condition and may positively impact patient outcomes.
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Lemierre syndrome associated with group A streptococcal infection. Am J Emerg Med 2010; 28:643.e5-8. [DOI: 10.1016/j.ajem.2009.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Accepted: 09/11/2009] [Indexed: 11/21/2022] Open
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Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus complicated by hemorrhagic pericarditis. Pediatr Crit Care Med 2010; 11:e32-5. [PMID: 20453608 DOI: 10.1097/pcc.0b013e3181b806cb] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe an infant with Lemierre-like syndrome caused by community-associated methicillin-resistant Staphylococcus aureus whose course was complicated by hemorrhagic pericarditis. DESIGN Case report. SETTING A 30-bed, pediatric intensive care unit at a tertiary care children's hospital. PATIENT A 7-month-old infant presented with fever and torticollis attributable to a retropharyngeal abscess and left internal jugular venous thrombosis. He was treated with antibiotics and anticoagulation, and his course was complicated by hemorrhagic pericarditis and cardiac tamponade. INTERVENTIONS Resuscitation of shock; video-assisted thoracoscopic drainage of bilateral empyema with pleural decortication; vancomycin and clindamycin treatment of methicillin-resistant Staphylococcus aureus; incision and drainage of retropharyngeal abscess; treatment of internal jugular venous thrombus with anticoagulation; and treatment of pericardial tamponade by insertion of pericardial drain. MEASUREMENTS AND MAIN RESULTS Methicillin-resistant Staphylococcus aureus from blood and pleural fluid peel cultures were multi-locus sequence type 8, Panton-Valentine leukocidin-positive, and contained SCCmec IV, findings consistent with USA300 pulsotype. There was complete recovery from this life-threatening infection. CONCLUSIONS Septic jugular venous thrombophlebitis complicating upper airway infections is a rare but serious acute medical condition. We present an infant with methicillin-resistant Staphylococcus aureus infection and clinical features that overlapped those described by Lemierre, in whom hemorrhagic pericarditis developed while receiving anticoagulation therapy. Anticoagulation, if used, should be closely monitored in this population.
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Role of methicillin-resistant Staphylococcus aureus in head and neck infections. The Journal of Laryngology & Otology 2009; 123:1301-7. [DOI: 10.1017/s0022215109990624] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe prevalence of infection with methicillin-resistant Staphylococcus aureus is increasing. Methicillin-resistant Staphylococcus aureus is also being recognised as an important pathogen in head and neck infections. This review summarises studies published over the past two decades which illustrate the growing prevalence of methicillin-resistant Staphylococcus aureus, and the current therapeutic approaches to head and neck infections caused by this bacterium. These infections include sinusitis, otitis, periorbital cellulitis, cervical lymphadenitis, tonsillitis, thyroiditis, retropharyngeal abscess, and abscesses and wounds of the neck. Treatment of head and neck infections associated with methicillin-resistant Staphylococcus aureus includes drainage and debridement, as well as administration of local and systemic antimicrobials that provide coverage against these organisms and against potential aerobic and anaerobic pathogens that may be present if the infection is polymicrobial.
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Lemierre Syndrome Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e3181a4c755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kadhiravan T, Piramanayagam P, Banga A, Gupta R, Sharma SK. Lemierre's syndrome due to community-acquired meticillin-resistant Staphylococcus aureus infection and presenting with orbital cellulitis: a case report. J Med Case Rep 2008; 2:374. [PMID: 19063718 PMCID: PMC2628934 DOI: 10.1186/1752-1947-2-374] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 12/08/2008] [Indexed: 11/28/2022] Open
Abstract
Introduction Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein leading to metastatic septic complications following an oropharyngeal infection. It is usually caused by the anaerobe, Fusobacterium necrophorum. Of late, meticillin-resistant Staphylococcus aureus is increasingly being recognised as a cause of community-acquired skin and soft tissue infections. We report a rare case of Lemierre's syndrome caused by community-acquired meticillin-resistant Staphylococcus aureus infection. Case presentation A previously healthy 16-year-old girl presented with fever of 13 days duration, painful swelling around the right eye and diplopia followed by the appearance of pulmonary infiltrates. Imaging studies confirmed the clinical suspicion of bilateral jugular venous thrombosis with septic pulmonary embolism. Meticillin-resistant Staphylococcus aureus was isolated on blood cultures. The hospital course was complicated by massive haemoptysis and pulmonary aspiration necessitating mechanical ventilation. The patient subsequently made a complete recovery. Conclusion Lemierre's syndrome, although rare, is a potentially lethal but treatable complication of head and neck sepsis. Early clinical recognition of Lemierre's syndrome and appropriate antibiotic treatment can be life-saving. One should consider the possibility of community-acquired meticillin-resistant Staphylococcus aureus infection in patients with suspected Lemierre's syndrome.
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Santschi M, David M, Garel L, Vanasse M, Gauvin F. Lemierre Syndrome: Two Preschool Children with Cerebral Infarcts. CLINICAL MEDICINE. PEDIATRICS 2008. [DOI: 10.4137/cmped.s879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report two children who developed hemiparesis secondary to cerebral infarcts complicating Lemierre syndrome. The first case is a one-year-old patient who presented a left internal jugular vein thrombosis and a left carotid compression due to retropharyngeal cellulitis. The second case is a five-year-old girl who presented a left internal jugular vein and a right carotid artery thrombosis associated with an oropharyngeal cellulitis. Etiologic agents involved were Staphylococus aureus in the first case and Fusobacterium necrophorum in the second case. These cases call for vigilance among physicians for this rare syndrome, its unusual presentation and its associated severe complications.
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Affiliation(s)
| | | | | | - Michel Vanasse
- Division of Neurology, Hôpital Sainte-Justine, Université de Montréal, Montréal, Canada
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Shivashankar GH, Murukesh N, Varma MPS, Sharif IM, Glynn G. Infection by Panton-Valentine leukocidin-producing Staphylococcus aureus clinically mimicking Lemierre's syndrome. J Med Microbiol 2008; 57:118-120. [PMID: 18065677 DOI: 10.1099/jmm.0.47281-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lemierre's syndrome is an oropharyngeal infection which leads to severe septic thrombophlebitis of the internal jugular vein and metastatic abscesses of the lungs and other organs. It is usually caused by Fusobacterium necrophorum, a Gram-negative obligate anaerobe. An unusual case of Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus infection masquerading as Lemierre's syndrome is reported here. A 32-year-old fit and otherwise healthy male presented on Christmas morning with a boil on his left cheek for 2 days and generalized rash for 3 h. His general condition began to worsen, he developed facial swelling and loss of vision in the left eye and was transferred to the intensive care unit. His treatment was taken over by team of specialists and further investigations revealed thrombophlebitis of the left internal jugular vein and cavernous sinus thrombosis with multiple brain infarcts and lung abscesses. His condition remained critical with multiple cranial nerve involvement despite being on broad-spectrum antibiotics. Blood cultures grew S. aureus which was producing PVL toxin. He improved gradually over several weeks. He underwent intensive physiotherapy and made a good recovery. Although a rare entity, it is important to consider Lemierre's syndrome in septic patients who present with rapidly worsening symptoms.
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Affiliation(s)
| | | | - M P S Varma
- Erne Hospital, Enniskillen, Fermanagh BT74 6AY, UK
| | | | - Gerard Glynn
- Erne Hospital, Enniskillen, Fermanagh BT74 6AY, UK
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Puymirat E, Biais M, Camou F, Lefèvre J, Guisset O, Gabinski C. A Lemierre syndrome variant caused by Staphylococcus aureus. Am J Emerg Med 2008; 26:380.e5-7. [DOI: 10.1016/j.ajem.2007.05.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Accepted: 05/16/2007] [Indexed: 10/22/2022] Open
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Bentley TP, Brennan DF. Lemierre's syndrome: methicillin-resistant Staphylococcus aureus (MRSA) finds a new home. J Emerg Med 2008; 37:131-4. [PMID: 18280087 DOI: 10.1016/j.jemermed.2007.07.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 05/23/2007] [Accepted: 07/14/2007] [Indexed: 10/22/2022]
Abstract
Lemierre's syndrome is septic thrombophlebitis of the internal jugular vein, arising as a complication of an oropharyngeal infection. This thrombophlebitis frequently results in septic emboli to organs such as the lungs. The causative agent in most previously described cases is Fusobacterium necrophorum, an anaerobic Gram-negative organism. We present the case of an 8-year-old previously healthy girl who came to the Emergency Department with a 5-day history of left-sided neck pain and was subsequently diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) Lemierre's syndrome. MRSA has not previously been described in Lemierre's syndrome in the Emergency Medicine literature. The clinical presentation, findings, and management of the syndrome are discussed. Regardless of etiology, once the diagnosis of Lemierre's syndrome is made, long-term broad-spectrum intravenous therapy will be necessary.
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Affiliation(s)
- Thomas P Bentley
- Department of Emergency Medicine, Emergency Medicine Residency Program, Orlando Regional Medical Center, Orlando, Florida 32806-2093, USA
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Salyers WJ, Schnose C, Zarchan A. No simple sore throat. Am J Med 2007; 120:860-2. [PMID: 17904456 DOI: 10.1016/j.amjmed.2007.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 07/23/2007] [Accepted: 07/23/2007] [Indexed: 11/21/2022]
Affiliation(s)
- William J Salyers
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, KS 67214, USA.
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Boga C, Ozdogu H, Diri B, Oguzkurt L, Asma S, Yeral M. Lemierre syndrome variant: Staphylococcus aureus associated with thrombosis of both the right internal jugular vein and the splenic vein after the exploration of a river cave. J Thromb Thrombolysis 2007; 23:151-4. [PMID: 17221323 DOI: 10.1007/s11239-006-9050-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2006] [Accepted: 12/01/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lemierre syndrome is a rare and potentially fatal entity characterized by septic emboli from thrombosis of the internal jugular vein after oropharyngeal infection. The etiologic agent is not always an anaerobic bacterium. We report a patient with a Lemierre syndrome variant who presented with thrombosis of both the right internal jugular vein and the splenic vein as well as septic pulmonary emboli caused by Staphylococcus aureus, which proved resistant to methicillin, amoxicillin, and ciprofloxacin. The patient was thought to have acquired the infection during the exploration of a river cave in Turkey 10 days before his admission to the hospital. Such caves are natural reservoirs of infectious microorganisms. METHODS The patient had a physical examination, coagulation screening tests, tests of thrombin generation and fibrinolysis, coagulation inhibitors, activated protein C resistance, early and late serological tests (including autoantibodies), computed tomographic studies of the chest and abdomen, and bacterial examination of peripheral blood. Bacterial investigations were made on samples collected from the river cave. RESULTS After having undergone a 6 week course of antimicrobial treatment and anticoagulant therapy, the patient recovered from the infection with no residual complications, and the signs and symptoms of Lemierre syndrome resolved. CONCLUSION The results probably indicate an exposure of the patient to soil-based Staphylococcus aureus. This observation suggests the action of environmental factors that may contribute to the development of this rare syndrome.
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Affiliation(s)
- Can Boga
- Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Baskent University, 06490 Ankara, Turkey.
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